Many conservative-leaning U.S. states and communities are nowhere near reaching the level of COVID-19 vaccination that could keep them safe from future outbreaks of the highly contagious Delta coronavirus variant, according to the latest data from the Centers for Disease Control and Prevention.
And numbers from the National Institutes of Health suggest they probably shouldn’t be relying on natural immunity to protect them, either.
Across America, the people most at risk of serious illness or death from COVID-19 — senior citizens — have been vaccinated at the highest rates so deaths and hospitalizations will never again reach their horrific winter highs. Overall, experts agree, the worst of the pandemic is behind us.
Even so, the Delta variant — which drove the massive wave of infection and death in India this spring — presents some very real risks. According to epidemiologists in the U.K., Delta (or B.1.617.2) is 40 to 60 percent more transmissible than the Alpha variant (B.1.1.7) that first emerged there in late 2020 and was itself up to 70 percent more transmissible than earlier versions of the virus.
As a result, Delta has quickly overtaken Alpha in the U.K., where COVID-19 cases — 91 percent of which are now Delta — have doubled over the last week. And while all two-dose COVID vaccines are effective against Delta when fully administered, the variant’s immune escape properties cut vaccine protection to just 33 percent in the period between the first dose and the second, according to a new study from Public Health England. (Vaccine protection from Alpha is 50 percent three weeks after the first dose, according to the study.)
This means, as another new U.K. study has shown, that while the current risk of infection is 1 in 22,455 for fully vaccinated U.K. residents, it rises to 1 in 7,901 for those who are partially vaccinated and 1 in 2,908 for the unvaccinated.
That’s why Delta is now driving “an epidemic among the unvaccinated and partially vaccinated populations in the U.K.,” Tim Spector, a professor of genetic epidemiology at King’s College London and the lead author of the second study, told the Financial Times earlier this week. “The U.K. has rapidly changed from one of the best performing nations to a nation again struggling with rising cases.”
Earlier this week, Dr. Anthony Fauci, America’s top infectious disease expert, said the variant’s spread and dominance in the U.K. could spell trouble for the U.S., where Delta now accounts for 6 percent of all infections — a figure that rises to 18 percent or higher in some Western states — and where the number of first vaccine doses administered each day has fallen by more than 80 percent over the last three weeks.
“We don’t want to let happen in the United States what is happening currently in the U.K., where you have a troublesome variant essentially taking over as the dominant variant,” Fauci warned. “We have within our power to [prevent] that by getting people vaccinated.”
But that’s the problem: not enough Americans living in conservative states and communities are getting jabbed to eliminate that possibility, particularly when masking and distancing are no longer in effect. And it’s not safe to assume that natural immunity will pick up the slack.
Why? Because there’s a lot less natural immunity in undervaccinated places than people might think.
The latest CDC data shows that the gap between vaccination rates in red states and blue states is vast, and it’s only getting wider. Right now, the 10 states that have fully vaccinated the smallest share of their residents are Mississippi (28 percent), Alabama (30 percent), Arkansas (32 percent), Louisiana (32 percent), Wyoming (33 percent), Tennessee (33 percent), Utah (34 percent), Idaho (34 percent), Georgia (34 percent) and Oklahoma (35 percent).
Meanwhile, the 10 states that have fully vaccinated the largest share of their residents are Vermont (60 percent), Massachusetts (57 percent), Maine (57 percent), Connecticut (56 percent), Rhode Island (54 percent), New Hampshire (53 percent), New Jersey (51 percent), Maryland (51 percent), Washington (49 percent) and New Mexico (49 percent).
With the exception of Georgia, every state on the low-vax list voted Republican in the 2020 presidential election. Every state on the high-vax list voted Democratic.
Likewise, the vast majority of the 100 U.S. counties with today’s highest per capita case counts are in conservative areas. According to the most recent Yahoo News/YouGov poll, more than three-quarters of Democrats (76 percent) say they’ve already been vaccinated, while less than half of Republicans (49 percent) say the same. A full 28 percent of Republicans say they will “never” get vaccinated.
Going forward, the hope for those living in undervaccinated areas is that even their slower inoculation rates will be sufficient, when combined with immunity acquired through prior infection, to keep dangerous variants like Delta from ever gaining traction — and COVID in general from making even a modest comeback.
That’s certainly possible. Right now, this kind of combined, population-level immunity is helping to hold cases to historic lows even in states where vaccinations lag.
But it’s no guarantee for the future.
"We are vulnerable," says Yahoo News Medical Contributor Dr. Kavita Patel, a primary-care physician and health-policy fellow at the Brookings Institution. "Come fall, when 100 percent of normal life is back, we could see spikes in areas with low vaccination rates."
There are two reasons for this. The first is that despite several huge nationwide surges — including a horrific holiday wave that saw COVID deaths exceed 4,000 on some days — the share of the population in undervaccinated states who were actually infected (and presumably acquired some degree of natural immunity) is still relatively small.
Take Mississippi. Again, just 28 percent of the population there has been fully vaccinated. According to the NIH’s dashboard of seroprevalence studies, the share of Mississippians who possess antibodies to SARS-CoV-2 was most recently estimated at 28 percent as well. Given that there’s significant overlap between the two groups — many people who have had COVID also end up getting vaccinated — that probably leaves more than half of Mississippi’s population susceptible to Delta (at a time when few residents are continuing to take any precautions).
And Mississippi is hardly an outlier. In fact, the most recent NIH antibody numbers are similar — or lower — across the other nine least vaccinated states: Alabama (30 percent), Arkansas (26 percent), Louisiana (15 percent), Tennessee (30 percent), Wyoming (29 percent), Idaho (19 percent), Utah (27 percent), Georgia (18 percent) and Oklahoma (19 percent).
In comparison, New Jersey’s antibody estimate (31 percent), combined with its much higher full-vaccination rate (51 percent of the total population, plus another 10 percent who have received their first dose), puts it much closer to herd immunity, the level of population-wide protection that experts say is required to keep COVID at bay. In some West Coast cities like Seattle and San Francisco, 70 percent of residents over the age of 12 have been fully vaccinated.
This stark contrast underscores the second reason why undervaccinated areas are potentially putting themselves in harm’s way when the weather changes and drives people indoors.
Scientists believe that full vaccination provides 88 percent protection against symptomatic disease from the Delta variant. But they don’t know how much protection prior infection by a different variant provides. In February 2021, researchers from India’s National Centre for Disease Control and CSIR Institute of Genomics and Integrative Biology reported that more than half of Delhi’s population already had SARS-CoV-2 antibodies — a higher number than any U.S. state, according to the NIH. But that did not stop a massive spring wave driven by Delta.
In other words, the more you rely on full vaccination — and the less you rely on natural immunity — the safer your state or community will be.
“This is a bit of a misunderstanding that unfortunately a lot of people have ... this idea that if you’ve been infected, you have natural immunity [and] you don’t need to get vaccinated,” Dr. Ashish Jha, dean of the Brown University School of Public Health, told CNN this week. “There is no doubt about it in my mind that a vaccine-induced immunity is much more durable and is going to hold up much better against the variants.”
Vaccine manufacturers "can even develop a totally new vaccine in under 100 days" in response to threats like Delta, says Patel. Yet in the end, science can only do so much. "The challenge would be getting everyone to take it."
None of which is to say that huge, holiday-level COVID surges are coming to conservative states and communities this summer or fall; in that regard, vaccinated residents will continue to protect unvaccinated residents from themselves.
But in the U.K., the number of people hospitalized with the virus has now risen above 1,000 for the first time since mid-May — and a greater share of the population there (42 percent) has been fully vaccinated than in all but three of the 25 U.S. states that voted Republican in the 2020 presidential election.
Already, U.S. hospitalizations have been skewing toward “people who are younger, people who have not been vaccinated," Dr. Krutika Kuppalli, an infectious disease expert at the Medical University of South Carolina, recently told the New York Times.
“I understand that in the short run we may get away with it, having slow vaccination rates,” Jha explained earlier this week. “But those people really are vulnerable — once we have more variants circulating in the United States — to get reinfected and potentially get very sick.”
If Jha is correct, Delta could soon lead to more COVID-19 illness and death in undervaccinated communities than in well-vaccinated communities. And while the numbers may not be as big as before, they will be all the more tragic because they could have been prevented.
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